Swedish prospective multicenter trial on the accuracy and clinical relevance of sentinel lymph node biopsy before neoadjuvant systemic therapy in breast cancer
| Autor: | Fuat Celebioglu, L. Zetterlund, Jana de Boniface, Rimma Axelsson, Jan Frisell |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Axillary lymph nodes medicine.medical_treatment Sentinel lymph node Neoadjuvant systemic therapy Context (language use) Breast Neoplasms 030230 surgery Sensitivity and Specificity 03 medical and health sciences Young Adult 0302 clinical medicine Breast cancer Multicenter trial medicine Humans Prospective Studies Neoadjuvant therapy Mastectomy Aged Sweden Radiotherapy business.industry False negative rate Sentinel Lymph Node Biopsy General surgery Axillary Lymph Node Dissection Middle Aged medicine.disease Pre-treatment Clinical Trial Neoadjuvant Therapy medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Identification rate Axilla Lymph Node Excision Female business |
| Zdroj: | Breast Cancer Research and Treatment |
| ISSN: | 1573-7217 0167-6806 |
| Popis: | Purpose The timing of sentinel lymph node biopsy (SLNB) in the context of neoadjuvant systemic therapy (NAST) in breast cancer is still controversial. SLNB before NAST has been evaluated in few single-institution studies in which axillary lymph node dissection (ALND), however, was commonly not performed in case of a negative SLNB. We investigated the potential clinical relevance of SLNB before NAST by performing ALND in all patients after NAST. Methods This national multicenter trial prospectively enrolled clinically node-negative breast cancer patients planned for NAST at 13 recruiting Swedish hospitals between October 2010 and December 2015. SLNB before NAST was followed by ALND after NAST in all individuals. Repeat SLNB after NAST was encouraged but not mandatory. Results SLNB before NAST was performed in 224 patients. The identification rate was 100% (224/224). The proportion of patients with a negative SLNB before NAST but positive axillary lymph nodes after NAST was 7.4% (nine of 121 patients, 95% CI 4.0–13.5). Among those with a positive SLNB before NAST, 23.2% (86/112) had further positive lymph nodes after NAST. Conclusions In clinically node-negative patients, SLNB before NAST is highly reliable. With this sequence, ALND and regional radiotherapy can be safely omitted in patients with a negative SLNB provided good clinical response to NAST. Additionally, SLNB-positive patients upfront will receive correct nodal staging unaffected by NAST and be consequently offered adjuvant locoregional treatment according to current guidelines pending the results of ongoing randomized trials. |
| Databáze: | OpenAIRE |
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